Clinical utility of the risperidone formulations in the management of schizophrenia

Figures & data

Figure 1 Mechanism of action of risperidone.

Abbreviations: 5HT2A, serotonin receptor 2A; D2, dopamine receptor 2; H1, histamine receptor 1; α1, adrenergic receptor 1; α2, adrenergic receptor 2.

Table 1 Cochrane risperidone reviews

Review	Sample/studies	For risperidone	Against risperidone
Rattehalli et al^Citation9 Risperidone vs placebo for schizophrenia	n = 1363, 10 RCTs	Greater reduction in PANNS/BPRS scores Less number of risperidone subjects left the trial owing to lack of efficacy	More EPSE but did not reach statistical significance Prolactin elevation
Hunter et al^Citation11 Risperidone vs typical antipsychotic medication for schizophrenia	n = 2368, 9 RCTs	Better outcomes in both short and long term trials Reduction in relapse rate Less extrapyramidal side effects	Weight gain Prolactin elevation and sexual side effects were comparable to haloperidol
Komossa et al^Citation14 Risperidone vs other atypical antipsychotics	n = 7760, 45 RCTs	Better PANNS score reduction than quetiapine and ziprasidone Better than ziprasidone in leaving study due to inefficacy Equal efficacy compared to aripiprazole and amisulpride	Olanzapine better on PANNS reduction Olanzapine and clozapine better than risperidone in leaving study due to inefficacy EPSE Prolactin elevation

Abbreviations: RCT, randomized controlled trial; PANNS, positive and negative syndrome scale; BPRS, brief psychiatric scale; EPSE, extra pyramidal side effects.

Table 2 Major recent studies involving risperidone

Study	Design	Results
Geddes et al^Citation63	Systematic review and meta-regression analysis 52 RCTs	No major difference between typical and atypical antipsychotics Olanzapine though associated with weight gain, was better tolerated than risperidone
Davis et al^Citation64	Meta-analysis 124 RCTs	Clozapine, olanzapine, risperidone, and amisulpride are more efficacious than FGAs
Leucht et al^Citation15	Meta-analysis 150 double blind studies	Amisulpride, risperidone, clozapine, and olanzapine were more efficacious than first-generation antipsychotics with small-tomedium effect sizes Aripiprazole, quetiapine, sertindole, ziprasidone, and zotepine were no different in efficacy from first-generation antipsychotics
Tiihonen et al^Citation65	Prospective cohort study using national central registers in Finland n = 2230	Clozapine, perphenazine depot, and olanzapine had the lowest rate of discontinuation Risperidone also had a significantly lower risk of all cause discontinuation compared with oral haloperidol Mortality was increased in patients not on antipsychotics
CATIE^Citation18	Double-blind RCT n = 1493	Phases 1 and 2 Phase 1: Olanzapine had the longest time to discontinuation; however had worsening of weight and metabolic profile. Risperidone was slightly more efficacious than quetiapine and ziprasidone. Clozapine was superior to risperidone in terms of improvement in positive symptoms (Phase 2E, n = 99)
	n = 444	Phase 2 T: Risperidone had advantages in those who discontinued medication owing to intolerability and olanzapine in those who discontinued owing to inadequate efficacy
CUtLASS^Citation17	12-month open-label trial n = 277	Compliance, quality of life, and effectiveness were similar between FGAs and SGAs
SOHO^Citation66	Observational, nonrandomized study design n = 6516	Olanzapine and clozapine were associated with a lower risk of relapse than risperidone, quetiapine, and typical antipsychotics

Abbreviations: RCTs, randomized controlled trials; FGAs, first-generation antipsychotics; CATIE, Clinical Antipsychotic Trials of Intervention Effectiveness trial; CUtLASS, Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study; SGAs, second-generation antipsychotics; SOHO, Schizophrenia Outpatient Health Outcomes study.

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